This audit process under the Affordable Care Act affects commercial insurers and is currently underway.
An Initial Validation Audit (IVA) is required for commercial risk adjustment health plans as part of the Affordable Care Act. Selecting a highly qualified IVA entity is one the most important decisions you will make in the HHS-RADV process. The accuracy of your results will have a significant impact on your plan’s financial performance.
The Initial Validation Audit (IVA) is a two-phase, regulatory audit required by the US Department of Health and Human Services (HHS). Issuers operating on the Health Insurance Exchange with more than $15 million in total premiums are required to participate in the IVA and must partner with a qualified IVA vendor to conduct the audit. Valiant Health, formerly Health Care Excel, was one of the first partners to offer IVA services during the pilot year (2015 & 2016) audits.
The HHS-RADV program will transfer funds from plans with lower risk scores to plans with higher risk scores in the individual and small group markets, both inside and outside the Health Insurance Exchanges. Issuers in states where HHS operates the Risk Adjustment (RA) program are required to engage an Initial Validation Auditor (IVA).
The HHS-RADV program will ensure that competition among insurers is based on the value and efficiency of their plans rather than favorable selection. HHS-RADV audits aim to:
- Reduce negative impact of adverse enrollee selection
- Stabilize premiums
- Reduce the number of uninsured individuals